ABSTRACT
Aim: To investigate impact of antenatal squatting activities on labour
outcomes. Methods: All eligible primigravida women, with singleton
cephalic fetuses, who presented to ward 18 of Colombo South Teaching Hospital,
Sri Lanka, during the period 1st of February to 28th of May 2017 were invited
into the study. Those who were already in active stage of labor (at least more
than two moderate contractions per 10 minutes) on admission were excluded.
Demographic data such as age, ethnicity, religion, educational level,
occupation, latrine type in use, and booking Body mass index (BMI) were
collected via an interviewer administered questionnaire. Data related to labor
(modified Bishop score at onset of active labor, labor augmentation, pain
relief, labor duration, mode of delivery, episiotomy or tears) and neonatal
outcome (birth weight, APGAR score at 1, 5, 10 minutes) were collected from
delivery notes. A pre tested interviewer administered questionnaire was used to
obtain data regarding routine squatting activities during the previous 6
months. Pain visual analogue scale was used on day after delivery to assess the
degree of labour pain. Duration of each squatting activity per day and number
of days engaged with the activity per week; were used to calculate total
squatting hours per week. In the absence of an accepted threshold for adequate
squatting, we employed the sample mean as an operational data-driven threshold
to define “more” against “less” squatting activities. Women who did not have
squatting activities were considered as the controls. We used chi-square and
Fisher’s exact tests to compare characteristics and outcomes between those
engaging in more and less levels of squatting activity. We fitted a series of
logistic regression models with each dichotomized outcome as the dependent
variable, more/less squatting activity as the main independent variable of
interest, and age, gestation period, BMI and patient’s occupation as
covariates. The resulting adjusted odds ratios (AOR) and their 95% confidence
intervals (CI) and statistical significance (p < 0.05) were used to draw
conclusions of adjusted associations. Results: We recruited 430 women
into this study. Overall, 68% of the women were of 20 - 30 years old, 47% had
normal body mass index and 65% were housewives. The most frequent squatting
activities were for urination/defecation and clothes washing (146 and 62
minutes/week, respectively). Mean total time was 246 minutes per week, of which
more than 147 women (34%) achieved above this level of squatting activities.
Those with more squatting activities had a greater modified Bishop Score ≥ 6/10
(92% vs 82%; p < 0.01); labor duration of <6 hours (82% vs 56%; p <
0.01), less likely for labour augmentation (39% vs 51%; p < 0.01) and pain
relief (53% vs 65%; p = 0.013). Similar results were obtained after adjustments
for maternal age, BMI, gestational age and occupation. However, there were no
significant differences in the mode of delivery (normal vaginal vs instrumental
vs caesarean), episiotomy rate, birth weight and neonatal Apgar scores. Conclusion: Squatting activities of more than 246 minutes per week may improve labor
outcome. Women should be encouraged to increase squatting exercises or incorporate
more habitual squatting activities antenatally.